Clinical Effectiveness of Different Irrigation Agents in Temporomandibular Arthrocentesis: Systematic Review and...

Background: Disorders of the temporomandibular joint (TMJ) affect millions worldwide and rank among the most frequent causes of orofacial pain unrelated to dental disease. Beyond discomfort, they can restrict mandibular motion and impair chewing efficiency. Arthrocentesis has been adopted as a favored surgical approach after conservative therapy fails since joint lavage can reduce inflammation and restore mobility with minimal invasiveness. A variety of irrigants are available for this procedure, including normal saline, Ringer's lactate, and ozonated water, each offering potential therapeutic advantages. However, the comparative effectiveness of these solutions in terms of pain reduction and functional recovery has not been clearly established, warranting systematic evaluation. Materials and Methods: Following PRISMA recommendations, a literature search was conducted in PubMed and ScienceDirect between 10 October and 14 November 2024. The search focused on studies published in English within the past ten years that examined arthrocentesis for temporomandibular joint disorders using normal saline, Ringer's lactate, or ozonated water as the irrigant. Results: Seven clinical trials involving 220 patients were included, of which three provided data suitable for meta-analysis. Qualitative synthesis indicated that all irrigants reduced pain (VAS) and improved maximum mouth opening (MMO), with ozonated water showing the greatest mean improvements (VAS reduction 6.2 points; MMO gain 12.9 mm). Ringer's lactate and saline also demonstrated clinically relevant effects. Quantitative analysis revealed no baseline group differences (VAS p = 0.800; MMO p = 0.935). Short-term (≤1 month) random effects models showed non-significant changes for VAS (Fisher's z = 1.32; 95% CI -2.64 to 0.00) and MMO (z = 0.04; 95% CI -0.14 to 0.21). At 3-6 months, ozonated water produced a statistically significant reduction in pain (z = -0.34; 95% CI -0.53 to -0.15), whereas MMO remained unchanged (z = 0.05; 95% CI -0.13 to 0.22). Conclusions: Arthrocentesis with any irrigant improves TMD symptoms. Ozonated water demonstrated the strongest long-term analgesic effect, but MMO improvements did not reach significance. Larger, standardized randomized trials are required to validate these findings.